Lymphedema and lymphocysts following lymphadenectomy may be prevented by omentoplasty: A pilot study

Objectives. Pelvic lymph node dissection as part of the staging surgery for cervical carcinoma interrupts the afferent lymphatics, so the lymph drains retroperitoneally. New surgical techniques designed to leave the peritoneu m open after the retroperitoneal dissection, in particular the application of a pedicled omentoplasty along the dissection route, have been advocated to prevent the formation of lymphocysts and lymphedema. We investigated the possible benefit of pedicled omentoplasty in preventing lymphocysts and ly mphedema following pelvic lymph node dissection. Methods. In this pilot study with historical controls we compared the forma tion of lymphocysts and lymphedema following two different surgical techniq ues for pelvic node dissection: group I (historical controls), in which the dorsal peritoneum was left open, and group II, in which the dorsal periton eum was left open with application of a pedicled omentoplasty. In these two groups of gynecologic patients, we compared the lymph flow patterns and th e occurrence of lymphedema following systemic pelvic lymphadenectomy. The t wo groups were of comparable clinical status and consisted of 12 (group I) and 10 (group II) patients. Lymphocysts, if any, were detected by CT scan, the lymph flow patterns were visualized by dynamic lymphscintography, and l ymphedema was visualized by physical examination and magnetic resonance ima ging of the groin and the upper leg. Results. In both groups a distinct intraperitoneal absorption of the lymph fluid was observed. Pedicled omentoplasty seemed to facilitate the absorpti on or transport of lymph fluid, resulting in less lymphedema in the upper l eg. Conclusion. It appeared that leaving the dorsal peritoneum open to give the lymph stream the opportunity to pour into the abdominal cavity is importan t in preventing lymphocysts and lymphedema. The dynamic lymphscintigraphy d escribed in this paper showed that the intraabdominal lymph flow is absorbe d by the peritoneum and even more quickly by the pedicled omentum. (C) 1999 Academic Press.